The validation of the short form of the Geriatric Depression Scale (GDS) in Greece

Age-related effects in magnitude and place-value processing

While general cognitive skills decline during aging, numerical skills seem to be mainly preserved. Such skills are essential for an independent life up to old age, e.g., when dealing with money or time. Operating with numbers usually requires number magnitude and place-value processing. The question is whether these processes are negatively affected by aging due to the general cognitive decline or positively affected due to lifelong experience with numbers. Therefore, we investigated age-related changes in the distance and compatibility effects in single-digit, two-digit, and four-digit number comparison. On the one hand, older adults took longer for number processing and showed a smaller distance effect, indicating altered number magnitude representations. On the other hand, older adults were better in place-value processing as indicated by a smaller compatibility effect than in younger adults. We conclude that aging differentially affects basic numerical skills.

The Efficacy of a Metacognitive Training Program in Amnestic Mild Cognitive Impairment: A 6-Month Follow-Up Clinical Study

This study was conducted in response to the increasing prevalence of Alzheimer's disease (AD) dementia and the significant risk faced by individuals with amnestic mild cognitive impairment with multiple-domain deficits (aMCI-md). Given the promising effects of MTPs, the primary aim of this study was to further explore their impact by assessing the maintenance of their benefits. Thus, 45 participants were randomly allocated in two groups: the Experimental group (n = 22), which received the metacognitive training program (MTP), and the Control group (n = 23) that received the cognitive exercises program (CEP). The training programs-the MTP and the CEP-included 10 individual sessions of a one-hour duration and took place once per week. To test the efficacy of the MTP, cognitive and metacognitive outcomes were compared between two groups-Experimental (EG) and Control (CG)-at four distinct time points: before-after-3 months-6 months after intervention. Based on this study's findings, the positive effects of the MTP were evident over a six-month period. Specifically, already three months post-training, the CG began to show a decline in training-related gains. In contrast, the EG's performance consistently improved, highlighting the superior efficacy of the MTP. Gains attributed to the MTP were detected in cognitive measures: cognitive flexibility and immediate visual recall, as well as in metacognitive measures: metacognitive control, improved metacognitive beliefs of attention, and an increased use of cognitive strategies. In conclusion, the results demonstrated the sustained effects of the MTP in cognitive and metacognitive measures over a period of six months, providing novel insight into the application and efficacy of the MTP in individuals with MCI.

The Relationship between Lifestyle, Mental Health, and Loneliness in the Elderly during the COVID-19 Pandemic

The study focused on examining the relationship between well-being and various psychological factors such as loneliness, anxiety, depression, and stress, whilst also considering changes in lifestyle. A total of 108 elderly participants, with an average age of 70.38 years, were enrolled in this quantitative cross-sectional study. The research employed a battery of assessment tools including a Sociodemographic Data Questionnaire, Mini-Mental State Examination, Positive Mental Health Scale, Stress Perception Scale, Geriatric Anxiety Inventory, Geriatric Depression Scale (reduced version), Loneliness Scale, and International Physical Activity Questionnaire. Descriptive analysis was conducted in order to understand the distribution of scores across these variables, followed by the categorization of participants based on the reported alterations in eating and physical activity behaviors. Correlations between variables were assessed using Spearman correlation and an EBIC-LASSO network analysis. The findings indicated a potential detriment to the well-being of elderly individuals practicing social distancing, evidenced by heightened symptoms of loneliness, depression, anxiety, and stress, alongside the reported changes in dietary patterns and physical activity. The study underscores the importance of understanding the pandemic's impact on the well-being of older adults and advocates for longitudinal investigations to delineate the evolving effects of social distancing measures across different phases of the pandemic.

Exploring the occurrence and the risk factors of the desire for hastened death and depression in people with early-stage dementia in Greece

OBJECTIVES

To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death.

METHODS

A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded.

RESULTS

Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p = 0.009), marital status (p = 0.001), and depression (p < 0.001). The factor significantly associated with depression was age (p = 0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death.

SIGNIFICANCE OF RESULTS

The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD)

OBJECTIVES

To study (i) the prevalence of mild and moderate-to-severe depressive symptoms in the entire spectrum of cognitive ageing in Greece and (ii) the relationship between these symptoms and demographic and clinical data.

METHODS

The study was based on the randomly selected cohort of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). Depressive symptoms were assessed with the 15-item version of the Geriatric Depression Scale. Participants also received a comprehensive neuropsychological assessment, while the clinical diagnoses of dementia and mild cognitive impairment were established according to international diagnostic criteria. Statistical analyses relied on comparison tests and a logistic (proportional odds) ordinal regression model.

RESULTS

Depressive symptoms were detected in 19.5% of the 1936 study participants, while 11.3% of both people with MCI and dementia had moderate-to-severe depressive symptoms. The regression model revealed that older adults with more severe depressive symptoms were more likely female, cognitively impaired, less educated, were treated with psychotropic medication and lived in Attica versus Thessaly.

CONCLUSIONS

Since depressive symptoms were detected in almost one in five older adults, healthcare professionals in Greece should safeguard the timely detection and effective treatment of such symptoms and the post-diagnostic care of older adults with depression.

Metacognitive beliefs of efficacy about daily life situations and use of cognitive strategies in amnestic mild cognitive impairment: a cross-sectional study

Metacognition, the ability to monitor and regulate cognitive processes, is essential for individuals with Mild Cognitive Impairment (MCI) to accurately identify their deficits and effectively manage them. However, previous studies primarily focused on memory awareness in MCI, neglecting other domains affected in daily life. This study aimed to investigate how individuals with MCI perceive their abilities to handle various cognitively challenging situations representing real-life scenarios and their use of compensatory strategies. Thus 100 participants were recruited, including 50 with amnestic MCI with multiple deficits (aMCI) and 50 cognitively healthy controls (HC) matched in age and education. Participants completed three metacognitive scales assessing self-perceived efficacy in everyday life scenarios and one scale evaluating use of cognitive strategies. Results indicated that aMCI participants reported significantly lower self-efficacy in memory and divided-shifted attention scenarios compared to HC. Surprisingly, no significant group differences were found in the self-reports about the use of cognitive strategies. This suggests a potential gap in understanding or applying effective strategies for compensating cognitive deficits. These findings emphasize the importance of cognitive training programs targeting metacognitive knowledge enhancement and practical use of cognitive strategies that could enhance the quality of life for individuals with MCI.

Understanding the impact of socioeconomic and health factors on geriatric depression: A comparative study in rural and urban Bangladesh

Background and Aims

The prevalence of depression among the elderly is a growing concern, and this study examines the differences between urban and rural areas in terms of geriatric depression.

Methods

Using a two-stage random sampling approach in urban areas and a multistage random sampling approach in rural areas, the study surveyed 944 elderly individuals of both sexes.

Results

The results indicate that the prevalence of depression was high, with 52.5% of the elderly population experiencing mild to severe depression. The study found that increasing age, female gender, nuclear family structure, and involvement of housewives or others were significant factors affecting depression in urban areas, while increasing age and elderly people without spouses were significant factors in rural areas. Additionally, the study identified hearing impairment, asthma, and arthritis as risk factors for depression in rural areas, and bronchitis, heart disease, and thyroid illness as significant factors in urban areas.

Conclusion

These findings highlight the need for policymakers to focus on addressing the mental health needs of older people, particularly women and those without spouses.

Feasibility and Effects of Cognitive Training with the COGNIPLAT Game Platform in Elderly with Mild Cognitive Impairment: Pilot Randomized Controlled Trial

This study examines the effectiveness of a new multi-domain multimodal cognitive training game platform, COGNIPLAT, in improving cognitive performance in elderly with mild cognitive impairment (MCI). The platform combines standard serious games and cognitive stimulation leveraging virtual and augmented reality technologies. A double-arm, evaluator-blinded randomized controlled trial was conducted with 21 elderly participants in the MCI spectrum, with 11 in the intervention group (INT) and 10 in the control group (CTL). Feasibility was assessed in terms of adherence, effective learning, and perceived usefulness. The INT attended 24 training sessions, 60 minutes long, twice a week, whereas the CTL engaged in normal daily activities and usual care. Results showed that the INT had a statistically significant change in the Montreal Cognitive Assessment score, stages List B Recall, Short-term delayed Recall, and Long-term delayed Recall of the Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test-A and B test scores, Digit Span Test (DST) Forward Span, and Functional Activities Questionnaire score. A trend level difference was also found for the RAVLT Recognition and the DST Backward Span. No significant differences were found for the CTL in any of the metrics. The completion rate of the INT was 91%, and the attendance rate was 100% for participants who completed the follow-up segment of the study. The engagement level was high, and effective learning was observed between the participants. The perceived usability and usefulness of the game platform was assessed as high. This study provides evidence of a positive effect of a multi-domain multimodal-based cognitive training program in elderly with MCI, with broader benefits on cognition by inducing more cooperative transfer effects over different domains.

Resilience in Mild Cognitive Impairment (MCI): Examining the Level and the Associations of Resilience with Subjective Wellbeing and Negative Affect in Early and Late-Stage MCI

The current study examines the relationship between the cognitive state of participants [healthy-early mild cognitive impairment (MCI)-late MCI], some subjective wellbeing factors (positive emotions, engagement, positive relationships, meaning in life, accomplishment, and negative emotions), and negative psychological outcomes (depression, anxiety, stress), as well as psychological resilience. We expected that people with advanced MCI would perceive increased negative psychological outcomes, poorer psychological resilience, and lower levels of subjective wellbeing in contrast to early MCI and healthy participants. The study involved 30 healthy, 31 early, and 28 late MCI individuals. A series of questionnaires have been applied to assess the aforementioned constructs. To examine the hypotheses of the study, path analysis (EQS program) was applied. Results showed that early MCI persons maintain the same levels of positive emotions and feelings of accomplishment with healthy peers. Late-stage patients present those feelings in a diminished form, which adversely impacts psychological resilience. Individuals with early and late MCI exhibit negative emotions and stress that impact their resilience; however, those with early MCI experience greater stress, negative emotions, depression, and anxiety. These findings may be utilized to design psychological interventions for resilience enhancement and support brain health in elderly adults who are at risk of neurodegeneration.

Face-to-face vs. Telerehabilitation language and cognitive training in patients with multi-domain amnestic mild cognitive impairment

The recent coronavirus emergency raised the question of whether telerehabilitation could be as effective as conventional face-to-face intervention. The aim of the present study was to compared language and cognitive training delivered to patients from a distance, through telecommunication systems, for the same intervention conducted on a face-to-face mode in patients with multi domain amnestic MCI (md-aMCI). To this end, 30 patients diagnosed with md-aMCI took part in the present study. The participants divided into two groups; one group received conventional face-to-face training and the other group received Telerehabilitation training. Both groups received language training using paper and pencil tasks and cognitive training using the Rehacom software. The training lasted 15 weeks and was delivered twice a week, for 60 minutes per session. The conventional face-to-face mode had a significant impact on cognitive (delayed and working memory, processing speed, executive function, and attention) and language domains (naming, word recognition, and semantic fluency). The telerehabilitation method had a beneficial impact on delayed memory, naming, and semantic fluency. The results of our study provide evidence that both telerehabilitation and face-to-face language and cognitive training seem to have a positive impact in patients with md-aMCI, with face-to-face training improving more domains than telerehabilitation.

Metacognitive Differences in Amnestic Mild Cognitive Impairment and Healthy Cognition: A Cross-Sectional Study Employing Online Measures

This study aimed to examine metacognitive abilities in individuals diagnosed with amnestic mild cognitive impairment (aMCI) by using online metacognitive measures during cognitive tasks. A total of 100 participants were enrolled, all aged 50 or older (mean age = 61.98; SD = 6.27), and with a minimum of six years of education (mean = 14.95; SD = 2.94). The sample included 50 individuals with aMCI (34 females) and 50 healthy controls (HC) (33 females). Both groups underwent metacognitive versions of memory tasks (Doors and People) and executive functions tasks (Wisconsin Card Sorting Test). Metacognition was assessed through confidence ratings given after each answer (referred to as metacognitive monitoring) and the accuracy of the participants' decisions to include or exclude answers from their final scores (known as metacognitive control). The results showed that although individuals with aMCI were aware of their cognitive limitations-evidenced by their lower confidence ratings across all tasks-they still exhibited overconfidence relative to their actual performance. Moreover, they included a greater number of incorrect answers in their final scores compared to the healthy control group. These findings suggest that while individuals with aMCI retain some level of awareness, their self-evaluations appear to lack precision. This observation was consistent across both types of cognitive tasks. The results underscore the need for additional research to better understand metacognition in MCI as well as the interplay between metacognitive monitoring and control.

Metacognitive Strategy Training Improves Decision-Making Abilities in Amnestic Mild Cognitive Impairment

Mild cognitive impairment (MCI) is associated with deficits in decision-making, which is of utmost importance for daily functioning. Despite evidence of declined decision-making abilities, research on decision-making interventions for MCI is scarce. As metacognition seems to play an important role in decision-making, the present study's aim was to examine whether a metacognitive strategy training can improve MCI patients' decision-making abilities. Older adults-patients of a day care center, diagnosed with amnestic MCI (n = 55) were randomly allocated in two groups, which were matched in gender, age and educational level. Τhe experimental group (n = 27, 18 women, mean age = 70.63, mean years of education = 13.44) received the metacognitive strategy training in parallel with the cognitive and physical training programs of the day care center, and the active control group (n = 28, 21 women, mean age = 70.86, mean years of education = 13.71) received only the cognitive and physical training of the center. The metacognitive strategy training included three online meeting sessions that took place once per week. The basis of the intervention was using analytical thinking, by answering four metacognitive-strategic questions, to make decisions about everyday situations. To examine the efficacy of the training, the ability to make decisions about everyday decision-making situations and the ability to apply decision rules were measured. Both groups participated in a pre-test session and a post-test session, while the experimental group also participated in a follow-up session, one month after the post-test session. The results showed that the experimental group improved its ability to decide, based on analytical thinking, about economic and healthcare-related everyday decision-making situations after they received the metacognitive strategy training. This improvement was maintained one month later. However, the ability to apply decision rules, which requires high cognitive effort, did not improve. In conclusion, it is important that some aspects of the analytical decision-making ability of amnestic MCI patients were improved due to the present metacognitive intervention.

Lawton's Instrumental Activities of Daily Living for Greek-Speaking Adults with Cognitive Impairment: A Psychometric Evaluation Study with Additional Receiver Operating Characteristic Curve Analysis

One of the components of a dementia diagnosis is the assessment of functional abilities. These abilities are measured via screeners, such as the Instrumental Activities of Daily Living (IADL) scale. The IADL scale is a valid tool that has been adapted in many languages. This study aimed to provide a cut-off point and validate the Greek version of the IADL scale in populations with cognitive impairment. IADL data were collected from 132 individuals: 24 PD patients, 24 Parkinson's disease dementia (PDD) patients, and 24 AD patients. The remaining 60 participants were cognitive healthy adults (CHAs). The CHA group and the PD group served as the cognitively unimpaired group (CUG), while the PDD and AD groups served as the cognitively impaired group (CIG). Additionally, the MMSE, the AMTS, the Clock Drawing Test CDT, the Arizona Battery for Communication Disorders of Dementia (ABCD), the NPI, and the GDS-15 were administered to the participants. Statistically significant differences in the IADL scores were exhibited between all subgroups. The IADL scale showed high internal consistency (Cronbach's alpha = 0.890). A threshold equal to 6.00 (AUC = 0.888, p < 0.001) was estimated between the CUG and the CIG. Significant positive correlations were observed between IADL and MMSE (r = 0.764, p < 0.001), IADL and AMTS (r = 0.724, p < 0.001), IADL and ABCD (r = 0.702, p < 0.001), and IADL and CDT (r = 0.627, p < 0.001) results. Given the obtained results, the IADL scale is a valid tool for clinical use with high reliability and sensitivity. Also, the IADL scale is a valuable instrument for screening functional abilities associated with cognitive impairment.

Cognition and Functionality Were Not Affected Due to the COVID-19 Pandemic in People with Mild Cognitive Impairment and AD Dementia Attending Digital Non-Pharmacologic Interventions

BACKGROUND

The majority of previous studies showed that older adults with mild cognitive impairment (MCI) as well as Alzheimer's disease dementia (ADD) had impaired cognition and mood status, as well as increased behavioral disturbances after the first wave of the COVID-19 pandemic. However, there are still controversial data as regards the multifactorial impact of the restrictive measures on cognition, mood and daily function in older adults with MCI and ADD.

AIM

In the current study, the scope is to identify possible deterioration by means of cognitive and functional level due to mood and behavioral alterations during the second quarantine imposed in Greece between November 2020 and May 2021, as well as one year after the second quarantine, in May 2022.

METHODS

Participants were recruited from the two day centers of the Greek Association of Alzheimer Disease and Related Disorders (GAADRD). They underwent three yearly follow up assessments from May 2020 to May 2022 and participated in cognitive training interventions (through digital online means) during the aforementioned period. Mixed measures analyses of variance as well as path models were used for the study's purposes.

RESULTS

The study sample comprised 210 participants (175 people with MCI and 35 people with ADD). The mean age was 71.59 and 77.94 for people with MCI and mild ADD, respectively, whereas the average number of years of education was 12.65 for those with MCI and 9.83 for people with mild ADD. The results show that participants' deterioration rate (D), calculated by means of their performance in neuropsychological and functional assessments between 2020 and 2021 (D1) and 2021 and 2022 (D2), did not change significantly, except for the Rey Auditory Verbal Learning Test (RAVLT), since both groups displayed a larger D2 across the test conditions (immediate recall, fifth trial and delayed recall). Trail Making Test-B (TMT-B) performance, applied only in the MCI group, decreased more in relation to the deterioration rate D2. Additionally, two path models were applied to measure the direct relationships between diagnosis, performance in tests measuring mood and neuropsychiatric disturbances (NPI) and cognition, as measured by the RAVLT, in the 2020-2022 assessments. TMT-B was administered only in the MCI population, and therefore was not included in path models. The results show that participants' scores in RAVLT conditions were related to diagnosis and NPI performance, which was positively affected by diagnosis. No other relationships between RAVLT with mood tests were observed.

CONCLUSIONS

Our results show that after the second lockdown period, the neuropsychological performance of people with MCI and ADD, calculated by means of their D2, did not change, except from their verbal memory, as well as visual scanning and information processing, measured using the TMT-B. Therefore, it can be assumed that those who were enrolled in digital non-pharmacological interventions during the COVID-19 pandemic home restrictions did not experience increased cognitive and functional deterioration due to mood and behavioral alterations after the pandemic.

Old-age mental telehealth services at primary healthcare centers in low- resource areas in Greece: design, iterative development and single-site pilot study findings

BACKGROUND

Even though communities in low-resource areas across the globe are aging, older adult mental and cognitive health services remain mainly embedded in tertiary- or secondary hospital settings, and thus not easily accessible by older adults living in such communities. Here, the iterative development of INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) services addressing the mental and cognitive healthcare needs of older adults residing in low-resource areas of Greece is depicted.

METHODS

INTRINSIC was developed and piloted in three iterative phases: (i) INTRINSIC initial version conceptualization; (ii) A 5-year field testing in Andros island; and (iii) Extending the services. The INTRINSIC initial version relied on a digital platform enabling videoconferencing, a flexible battery of diagnostic tools, pharmacological treatment and psychosocial support and the active involvement of local communities in service shaping.

RESULTS

Ιn 61% of the 119 participants of the pilot study, new diagnoses of mental and/or neurocognitive disorders were established. INTRINSIC resulted in a significant reduction in the distance travelled and time spent to visit mental and cognitive healthcare services. Participation was prematurely terminated due to dissatisfaction, lack of interest or insight in 13 cases (11%). Based on feedback and gained experiences, a new digital platform, facilitating e-training of healthcare professionals and public awareness raising, and a risk factor surveillance system were created, while INTRINSIC services were extended to incorporate a standardized sensory assessment and the modified problem adaptation therapy.

CONCLUSION

The INTRINSIC model may be a pragmatic strategy to improve access of older adults with mental and cognitive disorders living in low-resource areas to healthcare services.

What Do Arithmetic Errors in the Financial Context Reveal? A Preliminary Study of Individuals with Neurocognitive Disorders

OBJECTIVES

Arithmetic errors in the financial context have been investigated mainly in cognitively normal Parkinson's disease (PD) patients and mildly impaired PD (PD-MCI) individuals. The aim of this study was to examine arithmetic errors in the financial context across neurocognitive disorders.

METHODS

Four hundred and twenty older adults from Greece were divided into four groups (110 patients with a diagnosis of Alzheimer's disease (AD), 107 patients with a diagnosis of mild cognitive impairment (MCI), 109 healthy controls and 94 Parkinson's disease dementia (PDD) patients). Their ages ranged from 65 to 98 years (M = 73.96, SD = 6.68), and the sample had a mean of 8.67 (SD = 4.08) years of education. For each of the AD patients, a counterpart matched by age, educational attainment and gender was selected from a larger group of participants.

RESULTS

Overall, the results reveal that healthy older adults did not commit arithmetic errors, but AD patients reported procedural errors in their responses to both questions. A high frequency of procedural errors was found in MCI patients' responses to the first question, while the errors in their responses to the second question cannot be categorized. Finally, in PDD patients, place value errors were reported for the first question, while more magnitude errors were made when responding to the second question.

CONCLUSIONS

These findings support that arithmetic errors within financial contexts are not the same across neurocognitive disorders, and numerical representations are not impaired not only in PDD, but also in AD and MCI. This information could be useful in cognitive assessments performed by neurologists and neuropsychologists as these types of errors may be indicators of specific brain pathologies.

Exploring Loneliness, Fear and Depression among Older Adults during the COVID-19 Era: A Cross-Sectional Study in Greek Provincial Towns

BACKGROUND

With the onset of the COVID-19 pandemic, life changed abruptly for older adults in Greece. Social isolation, lockdowns, the fear of serious illness and death, all contributed to an increased risk of developing depression.

OBJECTIVE

To explore the presence and severity of depression in older adults in Greek provincial towns during the pandemic and to explore any possible relationships with loneliness and fear.

METHODS

A convenience sample of 200 participants aged >65, completed a socio-demographic form, the Revised UCLA Loneliness Scale, the Geriatric Depression-15 Scale (GDS-15) and the COVID-19 Fear Scale (FCV-19S). Data were collected from April to May 2022.

RESULTS

The average age of participants was 76.6 years and 35.5% of the participants presented depressive symptoms (mean prevalenceof depression 5 ± 3.7). A moderate to low level of loneliness (mean value 39 ± 11.3) and a moderate level of COVID-19 fear (mean value 18.9 ± 6.5) were also experienced. Higher levels of loneliness were found among participants with lower perceived health status and among those participants registered in Primary Health and Social Care (PHSC) services. Loneliness was positively correlated with depression (r = 0.7, p < 0.001), and increased loneliness and depression were associated with an increase in fear of COVID-19 (r = 0.2, p = 0.01 for both).

CONCLUSIONS

During the pandemic, older adults experienced loneliness, fear of COVID-19 and depression which were positively associated with each other. It is imperative to develop PHSC policies that are aimed at addressing the mental health problems of the older population, which have been caused by the COVID-19 pandemic, through developing their resilience, offering psychological support and promoting social connections.

The Effects of Aerobic and Resistance Exercises on the Cognitive and Physical Function of Persons with Mild Dementia: A Randomized Controlled Trial Protocol

Dementia causes deterioration in cognitive and physical functions. The scope of this study is to investigate the effect of different exercise programs on cognitive functions and functionality of persons suffering from mild Alzheimer's disease (AD) by generating information on the exercise types and their parameters. A randomized controlled trial (RCT) will be performed involving aerobic and resistance exercise interventions, taking place both at the sample collection center and at home. Participants will be randomly divided into two different intervention groups and a control group. All groups will be assessed twice; once at baseline and once after 12 weeks. The primary outcome shall comprise the effect of exercise programs on cognitive functions using cognitive testing, such as Addenbrooke's Cognitive Examination-Revisited (ACE-R), Mini Mental State Examination (MMSE), Trail Making Test A-Β (TMT A-B), and Digit Span Test (DST): Digit Span Forward (DSF) and Digit Span Backward (DSB). The effect on functionality will be assessed using the Senior Fitness Test (SFT), Berg Balance Scale (BBS), and Instrumental Activities of Daily Living Scale (IADL) questionnaire. Secondary outcomes include the effect of exercise on depression using the Geriatric Depression Scale-15 (GDS-15), on physical activity using the International Physical Activity Questionnaire (IPAQ), as well as the participants' compliance with the intervention. This study will investigate the possible effect of intervention of different exercise types and the comparison between them. Exercise forms a low-cost and reduced-risk intervention.

Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment

OBJECTIVE

The aim of the present study was to investigate the efficacy and feasibility of a telerehabilitation program in multi-domain amnestic Mild Cognitive Impairment (md-aMCI). The study sample consisted of 30 patients with md-aMCI and aged 60-80 years.

METHODS

The participants were randomly divided into two groups. The Training Group (TG), which received cognitive training by using the RehaCom software as well as paper-pencil language training and the Control Group (CG) which received standard clinical care (e.g., psychotherapy or/and physiotherapy). Duration of the telerehabilitation intervention was 15 weeks (twice a week for 60 min/session).

RESULTS

Our results revealed that the neuropsychological performance of the TG group after the telerehabilitation intervention improved on a statistically significant level on the domains of delayed and working memory, confrontation naming, verbal fluency, and global cognition. Comparison between the TG and CG revealed a significant impact of the telerehabilitation program on the domains of memory (delay and working) and language (naming and verbal fluency) as well as global cognition performance.

CONCLUSION

The findings of the study are promising in that the telerehabilitation intervention appears to be a useful method in improving or stabilizing cognitive decline in md-aMCI individuals and was a particularly effective alternative approach during the period of the pandemic lockdown. Specifically, the beneficial impact of the telerehabilitation intervention on episodic memory (which is one of the first domains to show impairment in md-aMCI patients) provides us with hope and evidence that these types of interventions may be applied with similar success using face-to-face interventions.

Brain Volumes and Metacognitive Deficits in Knowledge of Self, Task and Strategies in Mathematics: A Preliminary Pilot One-Year Longitudinal Study in aMCI Patients Compared to Healthy Controls

Metacognitive knowledge has been little investigated in aMCI patients. The aim of this study is to examine whether there are specific deficits in knowledge of self, task and strategies in mathematical cognition, due its importance for everyday functioning, mainly due to its importance for financial capacity in old age. A total of 24 patients with a diagnosis of aMCI and one-to-one 24 matched individuals (similar age, education and gender) were examined at three time points in a year with a number of neuropsychological tests and a slightly modified version of the Metacognitive Knowledge in Mathematics Questionnaire (MKMQ). We analyzed longitudinal MRI data regarding various brain areas for the aMCI patients. Results indicated that the aMCI group differed in all MKMQ subscale scores at the three time points compared to healthy controls. Correlations were found only for metacognitive avoidance strategies and left and right amygdala volumes at baseline, while after twelve months correlations were found for avoidance and right and left parahippocampal volumes. These preliminary results highlight the role of specific brain regions that could be used as indices in clinical practice for the detection of metacognitive knowledge deficits that are found in aMCI.

Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression

Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer's disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation.

R4Alz-Revised: A Tool Able to Strongly Discriminate 'Subjective Cognitive Decline' from Healthy Cognition and 'Minor Neurocognitive Disorder'

BACKGROUND

The diagnosis of the minor neurocognitive diseases in the clinical course of dementia before the clinical symptoms' appearance is the holy grail of neuropsychological research. The R4Alz battery is a novel and valid tool that was designed to assess cognitive control in people with minor cognitive disorders. The aim of the current study is the R4Alz battery's extension (namely R4Alz-R), enhanced by the design and administration of extra episodic memory tasks, as well as extra cognitive control tasks, towards improving the overall R4Alz discriminant validity.

METHODS

The study comprised 80 people: (a) 20 Healthy adults (HC), (b) 29 people with Subjective Cognitive Decline (SCD), and (c) 31 people with Mild Cognitive Impairment (MCI). The groups differed in age and educational level.

RESULTS

Updating, inhibition, attention switching, and cognitive flexibility tasks discriminated SCD from HC (p ≤ 0.003). Updating, switching, cognitive flexibility, and episodic memory tasks discriminated SCD from MCI (p ≤ 0.001). All the R4Alz-R's tasks discriminated HC from MCI (p ≤ 0.001). The R4Alz-R was free of age and educational level effects. The battery discriminated perfectly SCD from HC and HC from MCI (100% sensitivity-95% specificity and 100% sensitivity-90% specificity, respectively), whilst it discriminated excellently SCD from MCI (90.3% sensitivity-82.8% specificity).

CONCLUSION

SCD seems to be stage a of neurodegeneration since it can be objectively evaluated via the R4Alz-R battery, which seems to be a useful tool for early diagnosis.

Stressful life events, general cognitive performance, and financial capacity in healthy older adults and Alzheimer's disease patients

BACKGROUND

The influence of stressful life events on general cognition and for the first time on financial capacity performance of patients with a diagnosis of Alzheimer's disease (AD) and in healthy controls (HC) is assessed.

METHODS

A total of 268 participants (122 patients and 146 HCs with similar demographics) were examined with a number of neuropsychological tests, including Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) for measuring financial capacity. The life change unit (LCU) method was also used.

RESULTS

HCs reported more stressful events than AD patients before the onset of the disease as the LCU load was higher for them (51.80 vs. 27.50), but in both groups the level of LCU load was far below 100, which is the threshold suggested for the induction of a psychosomatic disorder. The most frequently reported life event for AD patients was increased family arguments (n = 45/122), followed by increase in responsibilities (n = 32/122) and financial difficulties (n = 29/122), while the HC group reported problems within the family (n = 56/146), change in health status (n = 32/146), and a death of a beloved family member (n = 27/146). Regressions indicate no causal role for recent life events in the etiopathogenesis of AD, but an influence only of MMSE and diagnosis on financial capacity.

CONCLUSIONS

Stressful life events do not seem to be important in financial capacity and relevant vulnerability to financial exploitation for either HCs or AD patients; therefore clinicians should not consider them per se as a possible aggravating factor for financial deficits.

Better Understand to Better Predict Subjective Well-Being Among Older Greeks in COVID-19 Era: Depression, Anxiety, Attitudes Towards eHealth, Religiousness, Spiritual Experience, and Cognition

Despite similarities with previous pandemics, the potential physical and psychosocial impact of COVID-19 on older adults is still little investigated in Greece. This study examines the intercorrelations between subjective well-being/life satisfaction, depression, state anxiety, global cognitive function, attitudes towards eHealth, religiousness and spiritual experience in older adults during COVID-19. Results revealed that statistically significant negative correlations exist between subjective life satisfaction and depressive symptomatology as well as with religiousness, a finding that can be explained by the COVID-19 externally imposed religious practice restrictions. Subjective life satisfaction was positively correlated with overall cognition as measured by Mini-Mental State Examination (MMSE). MMSE was also negatively correlated with state anxiety, depression, and attitudes towards eHealth use. The best predictors of subjective well-being is global cognition (as measured by MMSE) and depressive symptomatology (measured by GDS). The conclusions of this study underscore the need to examine in more detail psychological variables during COVID-19 and quality of life in older adults.

Trajectories of Cognitive Impairment in Adults Bearing Vascular Risk Factors, with or without Diagnosis of Mild Cognitive Impairment: Findings from a Longitudinal Study Assessing Executive Functions, Memory, and Social Cognition

With the aging of the population, a key concern of both societies and health services is to keep the population cognitively healthy until the maximum age limit. It is a well-known fact that vascular aging has a negative effect on the cognitive skills of adults, putting them at greater risk of developing dementia. The present longitudinal study aimed to evaluate the main dimensions of cognition in two pathological groups with different health profiles: a group of adults with vascular risk factors (VRF) (n = 35) and a group of adults with vascular risk factors and mild cognitive impairment (VRF + MCI) (n = 35). The two groups were matched in age, education, and gender. They were assessed with extensive neuropsychological testing at three different times with a distance of about 8 months between them; the assessment regarded executive functions, memory capacity, and Theory of Mind abilities. The analyses carried out were (a) mixed-measures ANOVA, (b) repeated measures ANOVA, and (c) ANOVA. The findings showed that global cognitive status and short-term memory are the main cognitive abilities that decline in community dwelling people bearing VRF. Hence, this group of adults should be examined at least every 2 years for this decline. As regards people with both VRF and MCI, it seems that the assessment of Theory of Mind abilities can better capture their further impairment. Global cognitive status, task/rule switching function, and long-term memory (delayed verbal recall) were revealed as the abilities that clearly and steadily differentiate VRF people with and without MCI.

Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis

Aims

Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad).

Method

We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.

Results

While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.

Conclusion

Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.

Examining Voting Capacity in Older Adults with and without Cognitive Decline

BACKGROUND

Nowadays, controversy exists regarding the stage of cognitive decline and/or dementia where voting capacity is diminished.

AIM

To evaluate whether general cognitive status in advancing age predicts voting capacity in its specific aspects.

METHODS

The study sample comprised 391 people: 88 cognitively healthy older adults (CH), 150 people with Mild Cognitive Impairment (MCI), and 153 people with Alzheimer's disease dementia (ADD). The assessment included CAT-V for the voting capacity and Mini Mental State Examination (MMSE) for general cognitive ability. ANOVAs and ROC curves were the tools of statistical analysis towards (a) indicating under which MMSE rate participants are incapable of voting and (b) whether the CAT-V total score can discriminate people with dementia (PwADD) from people without dementia (PwtD).

RESULTS

Out of the six CAT-V questions, one question was associated with a low MMSE cutoff score (19.50), having excellent sensitivity (92.5%) and specificity (77.20%), whilst the other five questions presented a higher MMSE cutoff score, with a good sensitivity (78.4% to 87.6%) and specificity (75.3% to 81.7%), indicating that voting difficulties are associated with cognitive status. Secondarily, the total CAT-V score discriminates PwADD from PwtD of 51-65 years (sensitivity 93.2%/specificity 100%-excellent), PwADD from PwtD of 66-75 years (sensitivity 73.3%/specificity 97.1%-good), PwADD from PwtD of 76-85 years (sensitivity 92.2%/specificity 64.7%-good), whilst for 86-95 years, a cutoff of 9.5 resulted in perfect sensitivity and specificity (100%).

CONCLUSION

According to MMSE, PwADD have no full voting competence, whilst PwtD seem to have intact voting capacity. The calculated cut-off scores indicate that only people who score more than 28 points on the MMSE have voting capacity.

Establishment of Clinical Construct of Intrinsic Capacity in Older Adults and Its Prediction of Functional Decline

Background

The World Health Organization has conceptualised the health and healthcare of older adults around the concept of healthy ageing. Healthy ageing is defined as “the process of developing and maintaining the functional ability that enables well-being in older age”. This functional ability is the sum of two key factors: intrinsic capacity and interacting environment. This concept of intrinsic capacity encompasses a wide spectrum of health characteristics including the physiological and psychological changes associated with the ageing process. In general, IC declines from a high and stable state to an impaired status as people age. Monitoring individuals for changes in intrinsic capacity in the context of their environment will provide a holistic method of tracking the functioning of older adults at both a population and individual level, providing an opportunity to address any reversible factors of decline. However, this would require a clear and objective conceptualisation of the concept of intrinsic capacity.

Methodology

One hundred subjects were recruited via invitation by advertisement on the institute campus. Study participants underwent detailed physical examination and measurement of various physical and chemical biomarkers which were likely to represent intrinsic capacity as evidenced by the literature review. Outcomes measured were a decline in ADL, IADL, mortality and hospitalisation over a follow-up period of six months. Exploratory factor analysis (EFA) was done to obtain a clinical construct of the proposed entity of intrinsic capacity. Unpaired t-test and univariate logistic regression were used to check for the association between the composite score (IC) and its domains with the decline in ADL, IADL, mortality and hospitalisation.

Results

One composite score (composite IC score) and eight subfactors emerged. The composite score and subfactor domains showed good construct validity. Composite intrinsic capacity score and subdomains of strength and cognition were significantly different among subjects with and without ADL and IADL decline. Univariate logistic regression showed that composite intrinsic capacity score was a predictor of decline in ADL and IADL even after adjusting for age, sex, comorbidity status and education level of the subject with an adjusted odds ratio of 0.99 and 0.98, respectively. Subdomains of strength and cognition also predicted a decline in ADL and IADL independently.

Conclusion

The development of an objective construct of the concept of intrinsic capacity, using commonly measured clinical and biochemical parameters, is feasible and predictive of the subsequent functionality of an individual.

The Effect of Depressive and Insomnia Symptoms in Quality of Life among Community-Dwelling Older Adults

The purpose of this study was to investigate the effects of depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms on the quality of life among community-dwelling older adults in an urban area of central Greece. A cross-sectional study was conducted on 200 older adults (aged ≥ 60) collected from five Open Care Centers for Elderly People of the Municipality of Larissa, Greece. Data were obtained through a questionnaire that included demographic, socioeconomic, and health-related characteristics; the World Health Organization Quality of Life (WHOQoL)-Bref questionnaire; the Geriatric Depression Scale; and the Athens Insomnia Scale. The prevalences of depression, insomnia, and comorbid depression and insomnia were 28% (95% confidence interval (95% CI): 21.8-34.2%), 40.5% (95% CI: 33.7-47.3%), and 19% (95% CI: 13.5-24.5%), respectively. The mean WHOQoL-Bref score for all domains was approximately 14.50, with the highest mean value observed for psychological health (14.79 ± 2.60), followed by the physical health (14.49 ± 2.66), social relationships (14.39 ± 2.03), and environmental domains (14.32 ± 1.90). All WHOQoL-Bref domains were negatively correlated with depression and insomnia. Older adults with depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms had lower scores in all quality of life dimensions compared with those without.

The Impact of Socioeconomic Factors and Geriatric Syndromes on Frailty among Elderly People Receiving Home-Based Healthcare: A Cross-Sectional Study

Purpose: To evaluate frailty and its relationship with geriatric syndromes in the context of socioeconomic variables. Patients and Methods: In this cross-sectional study, elderly people aged 65 years old and over who received homecare in the reference region of Crete, Greece, were enrolled. Geriatric syndromes such as frailty, dementia, and depression were evaluated using the SHARE-Frailty Index (SHARE-Fi), the Montreal Cognitive Assessment (MoCA), and the Geriatric Depression Scale (GDS), respectively. Level of education, annual individual income, disability in Activities of Daily Living (ADL) and homebound status were also assessed as ‘socioeconomic factors.’ Results: The mean age of 301 participants was 78.45 (±7.87) years old. A proportion of 38.5% was identified as frail. A multiple logistic regression model revealed that elderly people with cognitive dysfunction were more likely to be frail (OR = 1.65; 95% CI: 0.55−4.98, p = 0.469) compared to those with normal cognition, but this association was not significant. Although elderly people with mild depression were significantly more likely to be frail (OR = 2.62; CI: 1.33−5.17, p = 0.005) compared to those with normal depression, the association for elderly people with severe depression (OR = 2.05, CI: 0.80−5.24, p = 0.134) was not significant. Additionally, comorbidity (OR = 1.06, CI: 0.49−2.27, p = 0.876) was not associated with frailty, suggesting that comorbidity is not a risk factor for frailty. In addition, patients with mild depression were significantly more likely to report frailty (OR = 2.62, CI:1.33−5.17, p = 0.005) compared to those with normal depression, whereas elders with an annual individual income (>EUR 4500) were less likely to be frail (OR = 0.45, CI: 0.25−0.83, p = 0.011) compared to those with <EUR 4500 per year. Conclusions: Our data analysis shows that higher annual individual income and mild depression were independently associated with frailty, suggesting that a lower poverty threshold and mild depression are risk factors for frailty.

Emotion Recognition in a Health Continuum: Comparison of Healthy Adults of Advancing Age, Community Dwelling Adults Bearing Vascular Risk Factors and People Diagnosed with Mild Cognitive Impairment

The identification of basic emotions plays an important role in social relationships and behaviors linked to survival. In neurodegenerative conditions such as Alzheimer's disease (AD), the ability to recognize emotions may already be impaired at early stages of the disease, such as the stage of Mild Cognitive Impairment (MCI). However, as regards vascular pathologies related to cognitive impairment, very little is known about emotion recognition in people bearing vascular risk factors (VRF). Therefore, the aim of the present study was to examine emotion recognition ability in the health continuum "healthy advancing age-advancing age with VRF-MCI". The sample consisted of 106 adults divided in three diagnostic groups; 43 adults with MCI, 41 adults bearing one or more VRF, and 22 healthy controls of advancing age (HC). Since HC were more educated and younger than the other two groups, the age-group and level of educational were taken into account in the statistical analyses. A dynamic visual test was administered to examine recognition of basic emotions and emotionally neutral conditions. The results showed only a significant diagnostic group x educational level interaction as regards total emotion recognition ability, F (4, 28.910) = 4.117 p = 0.004 η² = 0.166. High educational level seems to contribute to a high-level-emotion-recognition-performance both in healthy adults of advancing age and in adults bearing vascular risk factors. Medium educational level appears to play the same role only in healthy adults. Neither educational level can help MCI people to enhance their significantly lower emotion recognition ability.

Validation of the Greek version of the Abbreviated Mental Test Score: Preliminary findings for cognitively impaired patients of different etiology

BACKGROUND

Screening people's cognitive skills have been proven essential for reference to full assessment. These methods include short scales, such as the Abbreviated Mental Test Score (AMTS). The AMTS is a valid 10-item questionnaire that has been translated into many languages, but not in Greek yet. The aim of this study is the validation of the Greek version of the AMTS with an additional estimation of its cutoff scores.

METHODS

About 132 individuals [60 controls and 72 patients (24 with Parkinson's disease (PD), 24 with Parkinson's disease dementia (PDD), and 24 with Alzheimer's disease (AD)] participated in this study. All participants besides the AMTS completed the Mini Mental State Examination (MMSE), the Tuokko's Clock Drawing Test (CDT), the Instrumental Activities of Daily Living (IADL), the Arizona Battery for Communication Disorders of Dementia (ABCD), the Hellenic versions of the Neuropsychiatric Inventory (NPI), and the Geriatric Depression Scale (GDS-15).

RESULTS

Statistically significant differences were found between all subgroups for the AMTS. The AMTS showed high internal consistency (Cronbach alpha = 0.819 and coefficient omega ω = 0.814). A threshold equal to 6.50 (AUC: 0.908, p = 0.000) between groups with and without cognitive impairment was calculated. The AMTS was significantly correlated with the CDT, IADL, and MMSE.

CONCLUSION

The proposed version of the AMTS can distinguish between groups with and without cognitive impairment. Additionally, the AMTS is found to be clinically valid having high reliability and classification accuracy. Conclusively, it is a valuable instrument for screening different types of cognitively impaired patients.

Catastrophe Theory Applied to Neuropsychological Data: Nonlinear Effects of Depression on Financial Capacity in Amnestic Mild Cognitive Impairment and Dementia

Financial incapacity is one of the cognitive deficits observed in amnestic mild cognitive impairment and dementia, while the combined interference of depression remains unexplored. The objective of this research is to investigate and propose a nonlinear model that explains empirical data better than ordinary linear ones and elucidates the role of depression. Four hundred eighteen (418) participants with a diagnosis of amnestic MCI with varying levels of depression were examined with the Geriatric Depression Scale (GDS-15), the Functional Rating Scale for Symptoms of Dementia (FRSSD), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Cusp catastrophe analysis was applied to the data, which suggested that the nonlinear model was superior to the linear and logistic alternatives, demonstrating depression contributes to a bifurcation effect. Depressive symptomatology induces nonlinear effects, that is, beyond a threshold value sudden decline in financial capacity is observed. Implications for theory and practice are discussed.

What Biological Factors, Social Determinants, and Psychological and Behavioral Symptoms of Patients with Mild Alzheimer’s Disease Correlate with Caregiver Estimations of Financial Capacity? Bringing Biases Against Older Women Into Focus

This study examines the connection between biological factors, social determinants, and behavioral and psychological symptoms of dementia (BPSD) and the estimations of financial capacity made by caregivers of mild AD patients in Greece. Financial capacity estimations negatively correlated with biological sex of the patients (female), but Neuropsychiatric Inventory (NPI) scores were statistically lower for older females. BPSD (measured with NPI) was found to negatively correlate with estimates of financial capacity. The existence of delusions-hallucinations was reported in all males. No correlations were found between financial capacity estimations, actual cognitive and financial capacity performance, and all other included biological and social characteristics of the patients as well as their caregivers.

Self-Awareness of Cognitive Efficiency, Cognitive Status, Insight, and Financial Capacity in Patients with Mild AD, aMCI, and Healthy Controls: An Intriguing Liaison with Clinical Implications?

Objectives: This study compares objective measures of cognitive performance with subjective perception of specific performance on neuropsychological tests examining basic cognitive domains, including, for the first time, financial capacity. Additionally, differences in assessment between single- and multiple-domain aMCI, mild AD, and healthy elderly regarding insight are examined. Methods: Participants completed a number of neuropsychological tests and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). After every test, participants were asked to complete the Clinical Insight Rating scale (CIR) and to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. Results: These preliminary findings show significant differences in the self-assessment patterns of the four groups in measures of verbal memory, visuospatial perception and memory, executive functions, tests of attention, and financial capacity. Mild AD expressed the highest overestimations, followed by single- and multiple-domain aMCI as well as controls. Accuracy of self-report is not uniform across groups and functional areas. Conclusions: Unawareness of memory deficits in both MCI subtypes is contradictory to subjective memory complaints as being an important component for clinical diagnosis. Financial capacity is overestimated in MCI and mild AD, a finding that has a plethora of clinical and legal implications.

Episodic Memory in Amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s Disease Dementia (ADD): Using the “Doors and People” Tool to Differentiate between Early aMCI—Late aMCI—Mild ADD Diagnostic Groups

Episodic memory is the type of memory that allows the recollection of personal experiences containing information on what has happened and, also, where and when it happened. Because of its sensitivity to neurodegenerative diseases and the aging of the brain, it is considered a hallmark of Alzheimer’s disease dementia (ADD). The objective of the present study was to examine episodic memory in amnestic mild cognitive impairment (aMCI) and ADD. Patients with the diagnosis of early aMCI, late aMCI, and mild ADD were evaluated using the Doors and People tool which consists of four subtests examining different aspects of episodic memory. The statistical analysis with receiver operating characteristic curves (ROC) showed the discriminant potential and the cutoffs of every subtest. Overall, the evaluation of episodic memory with the Doors and People tool can discriminate with great sensitivity between the different groups of people with AD and, especially, early aMCI, late aMCI, and mild ADD patients.

Longitudinal Cognitive and Physical Training Effectiveness in MCI, Based on the Experience of the Alzheimer's Hellas Day Care Centre

This study assesses the effectiveness of a multicomponent Longitudinal Cognitive Training (CT) program plus physical exercise (PE) for people with Mild Cognitive Impairment (MCI). 155 people with MCI, completed a 3 years (3Y) CT+PE, whilst 133 were control. Neuropsychological assessment was performed at baseline and 3 years later, whilst CT+PE had additional annual assessments. According to the results, the 3Y CT+PE outperformed control in cognitive abilities (p < 0.002), and Activities of Daily Living (ADL) (p < 0.001), stabilized their functional performances between 1st and 2nd year, but worsened in working and verbal memory between 2nd and 3 rd year (p < 0.002). Control deteriorated in cognitive functions (p < 0.001) and ADL (p < 0.001) after 3 years, whilst 1.33% of the experimental and 13.53% of the control group progressed to dementia (p < 0.001). Longitudinal CT+PE improves cognitive performance and ADL in MCI and delay the progression to dementia.

Liberating older adults from the bonds of vascular risk factors: What is their impact on financial capacity in amnestic mild cognitive impairment?

BACKGROUND

There is a pressing need to clarify whether vascular risk factors (VRFs) are related to the heterogeneous cognitive performance found in mild cognitive impairment (MCI) and whether the number of VRFs relates to financial capacity impairment in patients with amnestic MCI (aMCI).

METHODS

A total of 112 participants were divided into three groups: patients with single-domain aMCI, patients with multiple-domain aMCI, and healthy controls (HCs), while taking into consideration whether participants had a diagnosis of one VRF or disease, or more than one VRF or disease. Patients with aMCI with VRFs (one and more than one VRF) and HCs did not differ significantly in age, education, and sex. Mini-Mental State Examination, 15-item Geriatric Depression Scale, and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) were administered to all groups.

RESULTS

Diagnosis (P <0.001) and VRFs (P = 0.006) showed significant main effects on LCPLTAS but no interaction (P = 0.654). Patients with aMCI with high vascular burden were more frequently of the multiple-domain subtype, whereas patients with no vascular burden were more frequently of the single-domain subtype. A larger vascular burden is correlated with lower LCPLTAS scores.

DISCUSSION

Vascular burden plays an important role in the heterogeneity of aMCI by impairing financial capacity.

Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT

Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers’ burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers’ burden.

Remote neuropsychological evaluation of older adults

The use of technological means in the process of neuropsychological assessment has been proposed as a technique with promising results in the field of detection of neurocognitive disorders for community-dwelling older adults. Especially during the pandemic period due to COVID-19, telemedicine assumed to be vital in the field of early diagnosis of cognitive disorders and highlighted the clinical utility of remote methods of neuropsychological assessmentby video-conference. This descriptive study presents the development of a remote neuropsychological assessment protocol by selecting appropriate validated tests as part of a more comprehensive evaluation for older adults dwelling in the community. We recruited participants from the Athens Alzheimer's Association center in collaboration with the Hellenic Neuropsychological Society, in Athens, Greece, regarding the period between April 2020 and October 2021. 90 individuals, tested for the first time, were categorized into three groups according to their diagnosis which included: (a) Mild Cognitive Impairment (MCI), (b) Alzheimer's disease, (c) cognitively healthy older adults. The presented protocol outlines the main considerations of a framework about remote neuropsychological assessment, which can maximize the effectiveness of interventions and continuity regarding the care of older adults. The recommendations outlined in the presented protocol highlight strengths and limitations that should be taken into account in remote control procedures. Although the protocol was created in response to pandemic restrictions, tele-neuropsychology shows promise as a way to improve access opportunity to neurodiagnostic services for rural aging and underserved populations, which lack specialized healthcare services. Further application to different populations will add validity to the presented descriptive protocol.

The factors associated with the presence of psychotic symptoms in the HELIAD Greek community study of older adults

BACKGROUND

The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.

METHODS

The sample includes n = 1,904 residents of the cities of Larissa and Maroussi in Greece participating in the Hellenic Longitudinal Investigation of Aging and Diet study with available data at baseline and n = 947 individuals at the 3-year follow-up. Past-month presence of delusions and hallucinations was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and 14 symptoms of the Neuropsychiatric Inventory Questionnaire. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Penalized logistic regression analyses were used to assess the socio-economic and clinical factors associated with psychotic symptoms.

RESULTS

Past-month prevalence of psychotic symptoms was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 0.8% and 0.3% when excluding dementia. The incidence of psychotic symptoms without dementia was 1.3%. Recent widows and farmers/breeders/craftsmen, versus public servants/teachers/executives, had both six times the odds of experiencing psychotic symptoms without dementia. Hearing impairment and the number of health conditions also increased the odds while increased age was protective.

CONCLUSION

Psychotic symptoms unrelated to dementia constitute a considerable mental health problem in old age. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

Dietary Inflammatory Index score and prodromal Parkinson's disease incidence: The HELIAD study

AIM

The aim of the present study was to investigate the association of the inflammatory potential of diet with prodromal Parkinson's disease (pPD) probability and incidence among community-dwelling older individuals without clinical features of parkinsonism at baseline.

METHODS

The sample consisted of 1,030 participants 65 years old or older, drawn from a population-based cohort study of older adults in Greece (Hellenic Longitudinal Investigation of Aging and Diet - HELIAD). We calculated pPD probability, according to International Parkinson and Movement Disorder Society research criteria. Dietary Inflammatory Index (DII) was used to measure the dietary inflammatory potential, with higher index score reflecting a more pro-inflammatory diet. Associations of baseline DII with pPD probability cross-sectionally, and with possible/probable pPD incidence (pPD probability ≥30%) during the follow-up period, were examined via general linear models and generalized estimating equations, respectively.

RESULTS

Cross-sectionally, one unit increase of DII score[DII (min, max) = -5.83, 6.01]was associated with 4.9% increased pPD probability [β=0.049, 95%CI (0.025-0.090), p<0.001]. Prospectively, 62 participants developed pPD during 3.1±0.9 (mean±SD) years of follow-up. One unit increase in DII was associated with 20.3% increased risk for developing pPD [RR=1.203, 95%CI (1.070-1.351), p=0.002]. Participants in the highest tertile of DII score were 2.6 times more likely to develop pPD [β=2.594, 95%CI (1.332-5.050), p=0.005], compared to those in the lowest tertile.

CONCLUSION

More pro-inflammatory diet was related with higher pPD probability and pPD incidence (pPD probability ≥30%) in a community-dwelling older adult population. Further studies are needed to confirm these findings.

The discriminant validity of Rey Complex Figure Test (RCFT) in subjective cognitive decline, mild cognitive impairment (multiple domain) and Alzheimer's disease dementia (ADD; mild stage) in Greek older adults

Aim: The goal of this study was to determine the discriminant potential of the Rey Complex Figure Test (RCFT) in older adults with Mild Cognitive Impairment multiple domain (mdMCI) and Alzheimer's Disease Dementia (ADD; mild subtype) as compared to older adults with Subjective Cognitive Decline (SCD).Materials and methods: We administered RCFT in 608 older adults, dividing them in three groups (217 individuals with SCD; 304 mdMCI population; 106 people with mild ADD, aged 50-90 years; M = 66.9, SD = 8.4) and a mean education of 10.20 (SD 4.3) years.Results: RCFT subtests have excellent discriminant validity, mainly between people with SCD and those with mild ADD. However, its discriminant validity in detecting older adults with SCD among mdMCI population is still questionable.Discussion: The use of RFCT in discriminating older adults with SCD from those with mild ADD both in research as well as in clinical practice is highly recommended.

Psychometric properties and modification of the 15-item geriatric depression scale among Chinese oldest-old and centenarians: a mixed-methods study

Background

The 15-item Geriatric Depression Scale (GDS-15) shows good performance in detecting depression among older persons, but its applicability has not been well studied in non-Western oldest-old adults and centenarians. This study aimed to evaluate the psychometric property of the GDS-15 and a simplified version among a large representative longevous population in China.

Methods

A total of 1624 individuals (786 oldest-old persons aged from 80 to 99 years; 838 centenarians aged 100+ years) participated in this study. Home interviews with structured questionnaires were conducted to collect sociodemographic data. Depressive symptoms were measured using the Chinese GDS-15 version. We implemented mixed methods for the psychometric evaluation of the GDS-15. Cronbach’s α coefficient and item-total correlation coefficients were used to evaluate the internal consistency. A standard expert consultation was conducted to test the content validity of each item. Multiple factor analyses were used to explore the optimal factor structure and measurement invariance.

Results

The α coefficient of the GDS-15 was 0.745, while two items impaired the overall consistency reliability. Nineteen experts rated the applicability for each item and provided removal suggestion. Five items with less validity were removed, and a simplified 10-item GDS model with three-factor structure was proposed as an optimal solution. The GDS-10 model showed factorial equivalence across age, sex, residence, and education in multi-group confirmatory factor analyses.

Conclusions

The original GDS-15 has acceptable internal reliability, known-group validity, and concurrent validity among Chinese community-dwelling oldest-old and centenarians; however we provided preliminary evidence indicating that individual items related to somatic function or social activities may not be applicable for this population. The modified GDS-10 can be proposed as a potentially more practical and comprehensible instrument for depression screening.

The association of basal cortisol levels with episodic memory in older adults is mediated by executive function

Elevated basal cortisol levels in elderly may indicate dysregulation of the internal stress-related system, as well as dysfunction and structural alterations in brain structures necessary for cognition, such as hippocampus and prefrontal cortex. Because of the close relation of executive functions and episodic memory processing, in this study we explored whether the association of elevated cortisol levels on episodic memory could be partly attributed to cortisol effects on executive functions. In this cross-sectional study we analyzed data from a sample of 236 community-dwelling older adults from the Cretan Aging Cohort aged 75.56 ± 7.21 years [53 with dementia due to probable Alzheimer's disease, 99 with Mild Cognitive Impairment (MCI) and 84 cognitively non-impaired participants (NI)]. Morning serum cortisol levels were higher in the probable AD as compared to the NI group (p = .031). Mediated regression models in the total sample supported the hypothesis that the negative association of basal cortisol levels with delayed memory was fully mediated by the relation of basal cortisol levels with executive functions and immediate memory (adjusted for age and self-reported depression symptoms). Moderated mediation regression models revealed that the direct effect of cortisol on executive function and the effect of executive function on delayed memory performance were statistically significant among participants diagnosed with MCI, while the immediate memory effect on delayed memory was more pronounced in AD patients, as compared to the NI group. The current findings corroborate neuroimaging research highlighting cortisol effects on executive functions and immediate memory and further suggest that dysregulation of systems involved in these functions may account for the purported detrimental long-term effects of high cortisol levels on delayed memory.